Intraindividual comparison of 1470nm diode laser versus carbon dioxide laser for tonsillotomy: A prospective, double-blind, randomized feasibility trial

Introduction: The need for reduction of post-tonsillectomy hemorrhage has led to promotion of tonsillotomy techniques for tonsil tissue reduction in obstructive tonsillar hypertrophy. This trial compares ablative tissue effects using 1470nm diode laser and carbon dioxide laser for tonsillotomy in an intraindividual design.

Methods: 21 children aged 2,5–13 years (mean age 6,1 years) underwent laser tonsillotomy for obstructive tonsillar hypertrophy in this double-blind, prospective, randomized, clinical feasibility trial. In each case, tonsillotomy was performed using fibre guided 1470nm diode laser (contact mode, 15 W power) on the one side and carbon dioxide laser (12 W power) on the other side. An independent physician documented clinical presentation and patients' symptoms preoperatively and on day 1, 3, 7, 14 and 21 postoperatively using standardized questionnaires including VAS for each side separately.

Results: Mean duration of operative treatment was 2.7min using 1470nm laser and 4.9min using carbon dioxide laser amounting to 125J and 816J total energy per tonsil respectively. Intraoperative bleeding and the use for bipolar forceps for coagulation was significantly less pronounced using 1470nm diode laser system. No infections, hemorrhages or other complications occurred postoperatively. There was no difference in postoperative pain scores between the carbon dioxide laser treated and the 1470nm fibre guided diode laser treated side.

Conclusions: A fiber-guided 1470nm diode laser system offers an efficient method for tonsillotomy in treatment of obstructive tonsillar hypertrophy. Compared with our standard practice (carbon dioxide laser), 1470nm laser application provides comparable tissue ablation effects with less intraoperative bleeding and shorter operation time.